Infectious Typhoid Flashcards
Fever
Abdominal pain
Enlarged peyer’s and mesenteric LN
Typhoid Enteric fever
Typhoid organism
S typhi
S paratyphi
Human host Food/water borne Fecal contamination by ill or asymptomatic chronic carrier Sexual Health care exposure
Typhoid
Clone H58 is resistant to
Quinolone
Not a known risk factor for enteric fever
Recent travel to SEA
Typhoid rf:
Contaminated food Flooding Sewage fertilized crop Ill household contact Prior H pylori infection (chronic reduced gastric content)
Most prominent typhoid symptom
Fever >75%
Abd pain 30-40-%
Milder form presenting with GI symptom
Paratyphi S
Rash of enteric fever
rose spot on trunk or chest
Early physical finding 30%
Faint salmon colored blanching maculopapular rash on trunk and chest
Salmonella can be cultured from punch biopsy
Rose spots
Life threatening GI complication such as bleeding and intestinal perforation occur during
3rd to 4th week
Neurologic manifestation 2-40%
Meningitis
GBS
Neuritis
Neuropsychiatric symptoms (muttering delirium or coma vigil)
Individuals are likely to become chronic carriers of S typhi
Female
Infant
Persons with biliary abnormality
Concurrent bladder infection / S. haematobium
S typhi pxs may excrete it in feces for up to
3 mos
Definitive dx of Typhoid
Isolation of S typhi from blood, bone marrow, sterile site, rose spot, stool
Gives more than 80% yield not reduced up to 5 d of prior antibiotic therapy
Bone marrow
Culture of intestinal secretion could br kbtajned by
duodenal string test
serologic test for febrile agglutinnin
Simple rapid limited sensitivity and specificity
Widal test
Typhoid tx
Fluoroquinolone cure rate of 98%
Relapse and fecal carriage rage <2%
Dsc strain
Ciprofloxacin
Typhoid vaccine
TY21a oral live attenuated
6 years
Enteric fever
Salmonella typhi
Salmonella para typhi
If not 2, non-enteric
Blood
1st week
Urine culture
2nd week
Stool culture
3rd week of illness
Brunner’s gland
Duodenum
Peyer’s
Ileum
Picking at bed clothes
Imaginary objects
coma vigil
Low utterences
Slurring of speech
Restlesness
Muttering delirium
Reservoir of salmonella
Gallbladder
Most prominent symptom
Fever
Roth spot
Infective endocarditis
Board like abdomen
Perforated typhoid ileitis
Most common site of perforation in bowel
Cecum
Cecum rupture is likely bec of
Law of laplace
The higher the diameter, the higher pressure
Single most sensitive method of diagnosis of Typhoid fever
Blood or bone marrow c
Empiric tx for typhoid
Ceftriaxone
Cephalosporins for empiric tx of enteric fever
Cefotaxime 2gm q8 IV
Cefixime 400mg BID PO
Ceftriaxone 2gm/day IV
Optimal tx for fully susceptible enteric fever in adult
Ciprofloxacin
